Summary ADVANCED PRACTICE NURSING PROCEDURES
◗ Informed consent required Determine the following. • Origin of the bite • Patient (If younger than 4 years old and older than 50 years, there is a greater risk of infection.) • Severity • Location • Size • Depth • Amount of contamination (puncture wound has greatest risk of infection) and amount of time that has elapsed between the bite and treatment. Keep in mind that an area of poor vascularity is at greater risk for infection and poor healing. Do a culture and Gram stain of the wound. PROCEDURE Bites Equipment • Basin—sterile • Povidone-iodine (Betadine) soak—povidone-iodine solution and 0.9% sterile sodium chloride mixed 50/50 • Gloves—sterile • Syringe—20 to 60 mL • Two needles—27 to 30 gauge and 18 to 20 gauge • 1% lidocaine • Scissors—sterile • Curved hemostats—sterile • Forceps—sterile • Suture—No. 3-0 to 5-0 nylon • 4 × 4 gauze—sterile • Culture swab • Topical antibiotic—Bactroban or Polysporin • Iodoform gauze—¼ to ½ inch Procedure • Culture the wound if the bite is 72 hours old. If the client has an elevated temperature, get a complete blood count, erythrocyte sedimentation rate, and possibly blood cultures. • If area of bite was on hands or feet, soak in povidone-iodine soak (50% povidone-iodine and 50% 0.9% sodium chloride) for 10 to 15 minutes. If unable to soak, irrigate with 250 to 500 mL of povidone-iodine/sodium chloride solution. 26 Section One | Dermatological Procedures • Anesthetize wound with 1% lidocaine. • Position the patient for comfort with the injured part easily accessible. • Cleanse the skin with antiseptic skin cleanser. • Irrigate the wound with 100 to 500 mL of sterile sodium chloride vigorously, using the syringe and 18-gauge needle. • Put on gloves. • Remove any devitalized tissue or foreign objects. • Insert iodoform gauze snugly with a ½ inch protruding from the wound. • Suture if the wound is clean and not a puncture. • Apply topical antibiotic. • Apply gauze dressing. Client Instructions • To prevent infection, abscess, cellulitis, septicemia, or osteomyelitis, take oral antibiotics (penicillin, amoxicillin/clavulanate [Augmentin], or erythromycin as prescribed) for 5 to 7 days. • Observe for signs and symptoms of infection, such as • Increase in pain after 24 hours • Increase in temperature • Redness or swelling • Yellow or greenish drainage • Foul odor • If any of these symptoms develop, return to the offi ce immediately. • To relieve pain • Take Tylenol No. 3 every 4 to 6 hours for 24 hours, then acetaminophen or ibuprofen every 4 to 6 hours for mild pain relief. • If fi ngers or toes are involved, exercise (wiggle) them frequently. • Elevate the wounded part above the heart for 48 hours or as long as possible. • Immobilize the wounded part for 48 hours. • Apply ice pack intermittently for the fi rst 24 hours. • Rabies—Consider rabies prophylaxis if the bite was from an animal. • Tetanus—Tetanus prophylaxis (Tdap) is needed if not received within 10 years. • Return to the offi ce in 2 days for a recheck
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advanced practice nursing procedures
